The present invention is directed to the assessment of certain biologically or medically significant characteristics of bodily structures, known as biomarkers, and more particularly to the assessment of biomarkers by quantitative measurement of their response to a stimulus.
The measurement of internal organs and structures from computed tomography (CT), magnetic resonance imaging (MRI), ultrasound, positron emission tomography (PET), and other imaging data sets is an important objective in many fields of medicine. These imaging modalities are quantitative assessments that, when used, are typically based on manual intervention by a trained technician or radiologist. Examples illustrating current applications of medical imaging include the measurement of the hippocampus in patients with epilepsy (Ashton E. A., Parker K. J., Berg M. J., and Chen C. W. xe2x80x9cA Novel Volumetric Feature Extraction Technique with Applications to MR Images,xe2x80x9d IEEE Transactions on Medical Imaging 16:4, 1997), the measurement of the biparietal diameter of the fetal head, and the measurement of cartilage thickness in bone (Stammberger, T., Eckstein, F., Englmeier, K-H., Reiser, M. xe2x80x9cDetermination of 3D Cartilage Thickness Data from MR Imaging: Computational Method and Reproducibility in the Living,xe2x80x9d Magnetic Resonance in Medicine 41, 1999; and Stammberger, T., Hohe, J., Englmeier, K-H., Reiser, M., Eckstein, F. xe2x80x9cElastic Registration of 3D Cartilage Surfaces from MR Image Data for Detecting Local Changes in Cartilage Thicknessxe2x80x9d, Magnetic Resonance in Medicine 44, 2000).
The need for accurate and precise measurements of organs, tissues, structures, and sub-structures continues to increase. For example, in following the response of a disease to a new therapy, the accurate representation of three-dimensional (3D) structures is vital in broad areas such as neurology, oncology, orthopedics, and urology. In human and animal anatomy texts, there are a great number of named organs, structures, and sub-structures. Furthermore, in disease states modifications to normal structures are possible and additional pathological structures or lesions can be present. Despite the imposing number of defined sub-structures and pathologies, within the major disease categories there are specific objects that serve as indicators of disease. For example, liver metastases, brain lesions, atherosclerotic plaques, and meniscal tears are some examples of specific indicators of different conditions. The topological, morphological, radiological, and pharmacokinetic characteristics of biological structures and sub-structures are called biomarkers, and specific measurements of the biomarkers can provide a quantitative assessment of disease progress. The ability to clearly and precisely quantify, distinguish and identify these biomarkers represents a needed and important step for an accurate, image-based assessment of both normal and disease states. Currently, medical imaging techniques such as MRI, CT, and ultrasound are used to assess biological structures and substructures and offer a limited degree of resolution.
In following the response of a person or animal to therapy, or to monitor the progression of disease, it is desirable to accurately and precisely monitor the trends in biomarkers over time. It is also very useful to obtain accurate measurements of these biomarkers over time, particularly to judge the degree of response to a new therapy, or to assess the trends often associated with increasing age. The prior art is capable of assessing gross changes over time. However, the conventional measurements are not well suited to assessing and quantifying subtle changes in lesion size, and are incapable of describing complex topology or shape in an accurate manner or of addressing finer details of biological structure(s).
In consideration of current medical imaging and tracking techniques, it becomes apparent that there are many disadvantages in using such technologies. As was noted earlier, many current imaging modalities require manual or semi-manual intervention by trained personnel. Interventions often include the usage of calipers (to derive measurement from radiographic films) and/or the use of a trackball or mouse. Additionally, user assisted interfaces are also employed to initiate some semi-automated algorithms (Ashton et al). The need for intensive and expert manual intervention is a disadvantage, since the demarcations can be tedious and prone to a high inter- and intra-observer variability. Furthermore, the typical application of manual measurements within two-dimensional (2D) slices, or even sequential 2D slices within a 3D data set, is not optimal since tortuous structures, curved structures, and thin structures are not well characterized within a single 2D slice, leading again to operator confusion and high variability in results. If these measurements are repeated over time on successive scans, then inaccurate trend information can unfortunately be obtained.
Yet another problem with conventional methods is that they lack sophistication and are based on xe2x80x9cfirst orderxe2x80x9d measurements of diameter, length, or thickness. These traditional measurements can be insensitive to small but important changes. As previously mentioned, the manual and semi-manual tracings of images lead to high intra- and inter-observer variability, and also lead to uneven or xe2x80x9craggedxe2x80x9d 3D structures. The accuracy of these measurements and their sensitivity to subtle changes in small sub-structures are highly dependent upon the resolution of the imaging system. Unfortunately, most CT, MRI, and ultrasound systems have poor resolution in the out-of-plane, or xe2x80x9czxe2x80x9d axis. While the in-plane resolution of these systems can commonly resolve objects that are just less than one millimeter in separation, the out-of-plane (slice thickness) is commonly set at 1.5 mm or even greater. For assessing subtle changes and small defects using xe2x80x9chigher orderxe2x80x9d structural measurements, it is desirable to have better than one millimeter resolution in all three orthogonal axes. Manual and semi-manual assessments of conventional biomarkers (such as major axis length or cross-sectional area) have a high inherent variability, so as successive scans are traced the variability can hide subtle trends. This means that only gross changes, sometimes over very long time periods, can be verified using conventional methods.
Some references for the prior work include:
Eckenstein F., Gavazzeni H. S., Sittek H., Haubner, M., Losch, A., Milz, S., Englmeier, K-H., Schulte, E., Putz, R, Reiser, M. xe2x80x9cDetermination of Knee Joint Cartilage Thickness using Three-Dimensional Magnetic Resonance Chondro-Crassometry (3D MR-CCM),xe2x80x9d Magnetic Resonance in Medicine 36: 256-265, 1996.
Solloway, S., Hutchinson, C. E., Waterton, J. C., Taylor, C. xe2x80x9cThe Use of Active Shape Models for Making Thickness Measurements of Articular Cartilage from MR Images,xe2x80x9d Magnetic Resonance in Medicine 37: 943-952, 1997.
Stammberger, T., Eckstein, F., Englmeier, K-H., Reiser, M. xe2x80x9cDetermination of 3D Cartilage Thickness Data from MR Imaging: Computational Method and Reproducibility in the Living,xe2x80x9d Magnetic Resonance in Medicine 41: 529-536, 1999.
Ghosh, S., Ries, M., Lane, N., Majundar, S. xe2x80x9cSegmentation of High Resolution Articular Cartilage MR Images,xe2x80x9d 46th Annual Meeting, Orthopaedic Research Society, Mar. 12-15, 2000, Orlando Fla.
Dardzinski, B. J., Mosher, T. J., Li, S., Van Slyke, M. A., Smith, M. B. xe2x80x9cSpatial Variation of T2 in Human Articular Cartilage. Radiology 205: 546-550, 1997.
Therasse, P., et al. xe2x80x9cNew Guidelines to Evaluate the Response to Treatment in Solid Tumors,xe2x80x9d Journal of National Cancer Institute, February 2000(92) 3: 205-216. This paper describes the standard (RECIST) for unidimensional tumor measurement.
Barseghian, T. xe2x80x9cUterine Fibroid Embolization Offers Alternative to Surgery,xe2x80x9d Diagnostic Imaging, September 1997, 11-12. This paper illustrates the awkwardness of the conventional mouse-driven manual outlining of lesions.
Yang, W., et al., xe2x80x9cComparison of Dynamic Helical CT and Dynamic MR Imaging in the Evaluation of Pelvic Lymph Nodes in Cervical Carcinoma,xe2x80x9d American Journal of Roentgenology, 2000 September; 175(3): 759-766.
Hermans, R., et al. xe2x80x9cThe Relation of CT-Determined Tumor Parameters and Local and Regional Outcome of Tonsillar Cancer after Definitive Radiation Treatment,xe2x80x9d International Journal of Radiation Oncology Biology-Physics. 2001 May 1; 50(1): 37-45.
Rovaris M, Inglese M, van Shijndel R A, et al. xe2x80x9cSensitivity and reproducibility of volume change measurements of different brain portions on magnetic resonance imaging in patients with multiple sclerosis,xe2x80x9d Journal of Neurology. 247(12): 960-965, 2000.
Sahani, D., et al. xe2x80x9cQuantitative Measurements of Medical Images for Pharmaceutical Clinical Trials: Comparison Between On and Off-Site Assessments,xe2x80x9d American Journal of Roentgenology, 2000 April; 174(4): 1159-1162.
The following references disclose prior art which is relevant but has limitations that the present invention transcends:
Prior work by Gilhuijs et al, U.S. Pat. No. 6,112,112, uses variance processing to derive a variance image. However, this work concerns changes in intensity as contrast agents flow into and out of a tumor.
Other work by Brasch et al, U.S. Pat. No. 6,009,342, attempts to determine a kinetic model of microvascular permeability. However, this work also pertains to the uptake and wash-out of contrast agents.
Other work by Scarth et al, U.S. Pat. No. 6,064,770, seeks to detect novelties in a data set, using the fuzzy C-Means clustering algorithm.
Other work by Olstad et al, U.S. Pat. No. 5,476,096, considers the processing of real-time ultrasound data sets in a way that is reminiscent of digital subtraction angiography.
In light of the aforementioned disadvantages, it becomes apparent that there is a clear need for improved imaging systems and methods. Moreover, there is a need for an invention which utilizes xe2x80x9chigher orderxe2x80x9d measurements to provide a previously unknown degree of resolution and quantification of biomarkers from their respective medical imaging data sets. Additionally, there is a need for an invention that incorporates these highly accurate and definitive images into a contiguous temporal framework, thus providing an accurate definition of trends over time.
Clearly, a need exists for improvement upon: (1) earlier methods of assessing and quantifying structures; (2) assessing the response of biomarkers in response to stimuli; (3) tracking change(s) of biological structure(s) and/or sub-structures over time; and (4) incorporating xe2x80x9chigher orderxe2x80x9d measurements. More precisely, there is a clear need for measurements that are more accurate and precise, with lower variability than conventional manual or semi-manual methods. There is furthermore a need for more accurate and precise assessment and measurement of biomarkers in response to stimuli. There is furthermore a need for measurements that are accurate over time, as repeated measurements are made. There is furthermore a need for measurements based on high-resolution data sets, such that small defects, tortuous objects, thin objects, and curved objects, can be quantified. Finally there is a need for measurements, parameters, and descriptors which are more sophisticated, more representative and more sensitive to subtle changes than the simple xe2x80x9cfirst orderxe2x80x9d measurements of length, diameter, thickness, area and volume.
To achieve the above and other objects, the present invention is directed to a system and method for accurately and precisely identifying important structures and sub-structures, their normalities and abnormalities, and their specific topological and morphological characteristicsxe2x80x94all of which are sensitive indicators of disease processes and related pathology. Biomarker measurements both before and after a stimulus are taken, so that the response of the biomarker to the stimulus can be determined. A stimulus can be applied (e.g., force, energy, or a chemical substance) or can be naturally occurring (e.g., disease progression).
The preferred technique is to identify the biomarkers based on automatic techniques that employ statistical reasoning to segment the biomarker of interest from the surrounding tissues (the statistical reasoning is given in Parker et al., U.S. Pat. No. 6,169,817, whose disclosure is hereby incorporated by reference in its entirety into the present disclosure). This can be accomplished by fusion of a high resolution scan in the orthogonal, or out-of-plane direction, to create a high resolution voxel data set (Pexc3x1a, J.-T., Totterman, S. M. S., Parker, K. J. xe2x80x9cMRI Isotropic Resolution Reconstruction from Two Orthogonal Scans,xe2x80x9d SPIE Medical Imaging, 2001). In addition to the assessment of subtle defects in structures, this high-resolution voxel data set enables more accurate measurement of structures that are thin, curved, or tortuous. More specifically, this invention improves the situation in such medical fields as oncology, neurology, and orthopedics. In the field of oncology, for example, the invention is capable of identifying tumor margins, specific sub-components such as necrotic core, viable perimeter, and development of tumor vasculature (angiogenesis), which are sensitive indicators of disease progress or response to therapy. Similarly, in the fields of neurology and orthopedics, the invention is capable of identifying characteristics of both the whole brain and prosthesis wear, respectively.
Generally speaking, biomarkers are biological structures and are thus subject to change in response to a variety of things. For example, the brain volume in a patient with multiple sclerosis may diminish after a period of time. In this case, a disease (multiple sclerosis) has caused a change in a biomarker (brain volume). More information on biomarkers and their use is found in the applicants"" co-pending U.S. patent application Ser. No. 10/189,476, filed Jul. 8, 2002, whose disclosure is hereby incorporated by reference in its entirety into the present disclosure. For a physician attempting to effectively monitor the progress of a disease via an image-based platform, an accurate, precise and temporally contiguous picture of the progress of the disease is needed. In light of the current state of imaging technology, however, the ability to accurately and precisely monitor disease progress on an image-based platform is non-existent. Thus, there is a need for the accurate and precise assessment of biomarkers by measuring their response to a stimulus. Per the present invention, the inventors define a stimulus as some applied force, substance, or energy that produces an effect or alteration in a biomarker. Stimuli include, but are not limited to:
any type of energy [e.g., ionizing energy, heat energy (temperature), non-ionizing energy]
any type of externally applied force (e.g., loading, mechanical stress/movement, motion)
any type of treatment modality (e.g., chemotherapy, radiation therapy, therapeutic compounds)
any type of disease process, including congenital, developmental, and infectious processes.
More specific examples of biomarkers that respond to stimuli include multiple sclerosis (lesion volume, whole brain volume, volume of a particular part of the brain, and intra-cranial cerebrospinal fluid volume), cancer (lesion volume, lesion surface area within one CT or MRI slice, major and minor axes within one slice, and the cross product of major and minor axes within one slice), and osteoarthritis (cartilage thickness, cartilage volume, image intensity of the cartilage and bone, and T2 relaxation time of the cartilage). This invention provides an improved system and method for assessing biomarkers in response to stimuli. This improvement is brought about by other improvements in the areas pertaining to the assessment and quantification of biomarkers, tracking changes of structures over time, and the sophistication of imaging methods.
It is desirable to accurately and precisely monitor the trends in biomarkers over time by assessing the response to a stimulus. For example, it is useful to monitor the condition of trabecular bone in patients with osteoarthritis. The inventors have discovered that extracting a biomarker using statistical tests and treating the biomarker over time as a four-dimensional (4D) object, with an automatic passing of boundaries from one time interval to the next, can provide a highly accurate and reproducible segmentation from which trends over time can be detected. This preferred approach is defined in the above-cited U.S. Pat. No. 6,169,817. Thus, this invention improves the situation by combining selected biomarkers that themselves capture subtle pathologies, with a 4D approach to increase accuracy and reliability over time, to create a sensitivity that has not been previously obtainable.
Although the conventional measures of length, diameter, and their extensions to area and volume are quite useful quantities, they are limited in their ability to assess subtle but potentially important features of tissue structures or substructures. Thus, the inventors propose to use xe2x80x9chigher orderxe2x80x9d measures of structure and shape to characterize biomarkers. The inventors define xe2x80x9chigher orderxe2x80x9d measures as any measurements that cannot be extracted directly from the data using traditional manual or semi-automated techniques, and that go beyond simple pixel counting. Length, area, and volume measurements are examples of simple first-order measurements that can be obtained by pixel counting. These higher order measures include, but are not limited to:
eigenfunction decompositions
moments of inertia
shape analysis, including local curvature
results of morphological operations such as skeletonization
fractal analysis
3D wavelet analysis
advanced surface and shape analysis such as a 3D spherical harmonic analysis with scale invariant properties
trajectories of bones, joints, tendons, and moving musculoskeletal structures
Mathematical theories of these higher order measurements can be found in Kaye, B. H., xe2x80x9cImage Analysis Procedures for Characterizing the Fractal Dimension of Fine Particles,xe2x80x9d Proc. Part. Tech. Conference, 1986; Ashton, E. et al., xe2x80x9cSpatial-Spectral Anomaly Detection with Shape-Based Classification,xe2x80x9d Proc. Military Sensing Symposium on Targets, Backgrounds and Discrimination, 2000; and Struik, D. J., Lectures on Classical Differential Geometry, 2nd ed., New York: Dover, 1988.
The present invention represents a resolution to the needs noted above. Moreover, and in sum, the present invention provides a method and system for the precise and sophisticated measurement of biomarkers, the accurate definition of trends over time, and the assessment of biomarkers by measurement of their response to a stimulus.
The measurement of internal organs and structures via medical imaging modalities (i.e., MRI, CT and ultrasound) provides invaluable image data sets for use in a variety of medical fields. These data sets permit medical personnel to objectively measure an object or objects of interest. Such objects may be deemed biomarkers and, per this invention, the inventors choose to define biomarkers as the abnormality and normality of structures, along with their topological and morphological characteristics and parameters, which may serve as sensitive indicators of disease, disease progress, and any other associated pathological state. For example, a physician examining a cancer patient may employ either MRI or CT scan technology to measure any number of pertinent biomarkers, such as tumor compactness, tumor volume, and/or tumor surface roughness.
The inventors have discovered that the following new biomarkers are sensitive indicators of the progress of diseases characterized by solid tumors in humans and in animals.
The following biomarkers relate to cancer studies:
Tumor surface area
Tumor compactness (surface-to-volume ratio)
Tumor surface curvature
Tumor surface roughness
Necrotic core volume
necrotic core compactness
necrotic core shape
Viable periphery volume
Volume of tumor vasculature
Change in tumor vasculature over time
Tumor shape, as defined through spherical harmonic analysis
Morphological surface characteristics
lesion characteristics
tumor characteristics
tumor peripheral characteristics
tumor core characteristics
bone metastases characteristics
ascites characteristics
pleural fluid characteristics
vessel structure characteristics
neovasculature characteristics
polyp characteristics
nodule characteristics
angiogenisis characteristics
tumor length
tumor width
tumor 3D volume.
The inventors have also discovered that the following new biomarkers are sensitive indicators of osteoarthritis joint disease in humans and in animals:
shape of the subchondral bone plate
layers of the cartilage and their relative size
signal intensity distribution within the cartilage layers
contact area between the articulating cartilage surfaces
surface topology of the cartilage shape
intensity of bone marrow edema
separation distances between bones
meniscus shape
meniscus surface area
meniscus contact area with cartilage
cartilage structural characteristics
cartilage surface characteristics
meniscus structural characteristics
meniscus surface characteristics
pannus structural characteristics
joint fluid characteristics
osteophyte characteristics
bone characteristics
lytic lesion characteristics
prosthesis contact characteristics
prosthesis wear
joint spacing characteristics
tibia medial cartilage volume
Tibia lateral cartilage volume
femur cartilage volume
patella cartilage volume
tibia medial cartilage curvature
tibia lateral cartilage curvature
femur cartilage curvature
patella cartilage curvature
cartilage bending energy
subchondral bone plate curvature
subchondral bone plate bending energy
meniscus volume
osteophyte volume
cartilage T2 lesion volumes
bone marrow edema volume and number
synovial fluid volume
synovial thickening
subchondrial bone cyst volume and number
kinematic tibial translation
kinematic tibial rotation
kinematic tibial valcus
distance between vertebral bodies
degree of subsidence of cage
degree of lordosis by angle measurement
degree of off-set between vertebral bodies
femoral bone characteristics
patella characteristics.
The inventors have also discovered that the following new biomarkers are sensitive indicators of neurological disease in humans and in animals:
The shape, topology, and morphology of brain lesions
The shape, topology, and morphology of brain plaques
The shape, topology, and morphology of brain ischemia
The shape, topology, and morphology of brain tumors
The spatial frequency distribution of the sulci and gyri
The compactness (a measure of surface to volume ratio) of gray matter and white matter
whole brain characteristics
gray matter characteristics
white matter characteristics
cerebral spinal fluid characteristics
hippocampus characteristics
brain sub-structure characteristics
The ratio of cerebral spinal fluid volume to gray mater and white matter volume
The number and volume of brain lesions.
The following biomarkers are sensitive indicators of disease and toxicity in organs:
organ volume
organ surface
organ compactness
organ shape
organ surface roughness
fat volume and shape.